The two experimental groups had about 60 participants each, so it was a relatively small study. (In general, the larger the study, the more reliable the findings.) Most participants were white women; mean age was 69. The experimental intervention ran for five months. An excerpt:

In one trial, the participants were randomized to a structured resistance training program in which three sets of 10 repetitions of eight upper and lower body exercises were done 3 days each week at 70% of one repetition maximum for 5 weeks, with or without calorie restriction of 600 calories per day.
In the second study, participants were randomized to an aerobic program which was conducted for 30 minutes at 65% to 70% heart rate reserve 4 days per week, with or without calorie restriction of 600 calories per day.

The beneficial bone effect was seen at the hip but not the lumbar spine.

Thin old bones—i.e., osteoporotic ones—are prone to fractures. Maintaining or improving bone mineral density probably prevents age-related fractures. In a five-month small study like this, I wouldn’t expect the researchers to find any fracture rate reduction; that takes years.

Most elders starting a weight-training program should work with a personal trainer.

I approached this book with trepidation. I like PD Mangan even though I’ve never met him. We’ve interacted on Twitter and at our blogs. You can tell from his blogging that he’s very intelligent. I don’t know his educational background but wouldn’t be surprised if he has a doctorate degree. My apprehension about the book is that I was concerned it would be brimming with malarkey and scams. Fortunately, that’s not the case at all.

Twin studies have established that 25% of longevity is genetic. That leaves a lot of lifestyle factors for us to manipulate.

I’m not familiar with the anti-aging scientific literature and don’t expect it will ever be something I’ll spend much time on. But it’s an important topic. I’ll listen to what other smart analysts—like Mr. Mangan—have to say about it.

It’s quite difficult to do rigorous testing of anti-aging strategies on free-living humans. So the best studies we have were done with worms, rodents, and monkeys; the findings may or may not apply to us. For example, long-term calorie restriction—about 30% below expected energy needs—is known to prolong life span in certain worms and rodents, with mixed results in rhesus monkeys. It’s the rare person who would follow such a low-calorie diet for years as an experiment. I doubt I would do it even if proven to give me an extra five years of life. I like to eat.

There are several prominent theories of how and why animals age. The author thinks the major factors are:

oxidative stress

inflammation

a decline in autophagy (perhaps most important)

An effective anti-aging program should address these issues.

In the anti-aging chapter of his book, The South Asian Health Solution, internist Ronesh Sinha says that “Lifestyle practices that reduce excess inflammation in the body will help delay the aging process.” Dr. Sinha is a huge exercise advocate and low-carb diet proponent.

Mr. Mangan makes a convincing argument that a good way to forestall aging is to apply hormetic stress. Hormesis is a phenomenon whereby a beneficial effect (e.g., improved health, stress tolerance, growth, or longevity) results from exposure to low doses of an agent or activity that is otherwise toxic or lethal when given at higher doses.

Needs a bit more hormetic stress

In case you’re not familiar with hormesis, here’s a major example. Lack of regular exercise leads is linked to premature death from heart disease and cancer. Starting and maintaining an exercise program leads to greater resistance to injury and disease and longer life span. On the other hand, too much exercise is harmful to health and longevity. We see that in professional athletes and excessive marathon runners. Something about exercise—in the right amount—enhances the body’s intrinsic repair mechanisms. That’s the hormetic effect of exercise; one mechanism is by turning on autophagy.

Autophagy is the body’s natural process for breaking down and removing or recycling worn-out cellular structures. This wearing-out occurs daily and at all ages.

If you’re thinking Mr. Mangan recommends exercise as an anti-aging strategy, you’re exactly right. Especially resistance training and high intensity training. His specific recommendations are perfectly in line with what I tell my patients.

Calorie restriction is another form of hormesis; the body reacts by up-regulating stress defense mechanisms. As a substitute for calorie restriction, the author recommends intermittent fasting. Intermittent fasting increases insulin sensitivity, which leads to enhanced autophagy. Fasting seems perfectly reasonable if you think about it, which very few do. Many of us eat every three or four hours while awake, whether a meal or a snack. If you think about it, that’s not a pattern that would be supported by evolution. In the Paleolithic era, we often must have gone 12–16 hours or even several days without food. Hominins without the resiliency to do that would have died off and not passed their genes down to us.

Another anti-aging trick is a low-carb diet, defined as under 130 grams/day, or under 20% of total calories. It may work via insulin signaling and weight control.

Glutathione within our cells is a tripeptide antioxidant critical for clearing harmful reactive oxygen species (free radicals). We need adequate glutathione to prevent or slow aging. Cysteine is the peptide that tends to limit our body’s production of glutathione. We increase our cysteine supply either through autophagy (which recycles protein peptides) or diet. Dietary sources of cysteine are proteins, especially from animal sources. Whey protein supplements and over-the-counter n-acetyl cysteine are other sources. Fasting is another trick that increases cysteine availability via autophagic recyling.

I don’t recall the author ever mentioning it, but if you hope to maximize longevity, don’t smoke. Even if it has hormetic effects. Maybe that goes without saying in 2015.

When I read a book like this, I always run across tidbits of information that I want to remember. Here are some:

those of us in the top third of muscular strength have a 40% lower risk of cancer (NB: you increase your strength through resistance training not aerobics)

in the author’s style of intermittent fasting, you’re not reducing overall calorie intake, just bunching your calories together over a shorter time frame (e.g., all 2,500 calories over 6-8 hours instead of spread over 24)

The author provides very specific anti-aging recommendations that could be followed by just about anyone. Read the book for details. Scientists are working feverishly to develop more effective anti-aging techniques. I look forward to a second edition of this book in three to five years.

PS: People with certain medical conditions, such as diabetics taking drugs that can cause hypoglycemia, should not do intermittent fasting without the blessing of their personal physician. If you have any question about your ability to fast safely, check with your doctor.

Compared to placebo, the drug-takers saw a 25-50% increase in muscle mass and strength. The authors attribute the benefit to inhibition of cyclooxygenase (COX).

In case you’re tempted to try this hack on yourself, you might want to run it by your doctor first. For instance, I wouldn’t take the acetaminophen if I had chronic liver disease. I’d eschew the ibuprofen if I had kidney impairment, were prone to bleeding, had stomach ulcers or gastritis, or were taking a strong blood thinner.

We recommend that appreciably the same muscular strength and endurance adaptations can be attained by performing a single set of ~8-12 repetitions to momentary muscular failure, at a repetition duration that maintains muscular tension throughout the entire range of motion, for most major muscle groups once or twice each week. All resistance types (e.g. free-weights, resistance machines, bodyweight, etc.) show potential for increases in strength, with no significant difference between them, although resistance machines appear to pose a lower risk of injury.

Resistance or weight training may be just as effective as, or even superior to, aerobic training in terms of overall health promotion. Plus, it’s less time-consuming according to a 2010 review by Stuart Phillips and Richard Winett.

I don’t like to exercise but I want the health benefits. So I look for ways to get it done quickly and safely.

Here’s a quote:

A central tenet of this review is that the dogmatic dichotomy of resistance training as being muscle and strength building with little or no value in promoting cardiometabolic health and aerobic training as endurance promoting and cardioprotective, respectively, largely is incorrect.

Over the last few years (decade?), a new exercise model has emerged. It’s simply intense resistance training for 15–20 minutes twice a week. It’s not fun, but you’re done and can move on to other things you enjoy. None of this three to five hours a week of exercise some recommend. We have no consensus on whether the new model is as healthy as the old.

only 10–15% of middle-aged or older adults in the U.S. practice RT whereas 35% engage in aerobic training (AT) or physical activity to meet minimal guidelines

they propose RT protocols that are brief, simple, and feasible

twice weekly training may be all that’s necessary

RT has a beneficial effect on LDL cholesterol and tends to increase HDL cholesterol, comparable to effects seen with AT

blood pressure reductions with RT are comparable to those seen with AT (6 mmHg systolic, almost 5 mmHg diastolic)

RT improves glucose regulation and insulin activity in those with diabetes and prediabetes

effort is a key component of the RT stimulus: voluntary fatigue is the goal (referred to as “momentary muscular failure” in some of my other posts)

“In intrinsic RT, the focus and goal are to target and fatigue muscle groups. A wide range of repetitions and time under tension can be used to achieve such a goal. Resistance simply is a vehicle to produce fatigue and only is adjusted when fatigue is not reached within the designated number of repetitions and time under tension.”

Our thesis is that an intrinsically oriented (i.e., guided by a high degree of effort intrinsic to each subject) program with at minimum of one set with 10–15 multiple muscle group exercises (e.g., leg press, chest press, pulldown, overhead press) executed with good form would be highly effective from a public health perspective.

The authors cite 60 other sources to support their contentions.

These ideas are the foundation of time-efficient resistance training of the sort promoted by Dr. Doug McGuff, Skyler Tanner, Fred Hahn, Chris Highcock, James Steele II, and Jonathan Bailor, to name a few.

Only a minority will ever exercise as much as the public health authorities recommend. This new training model has real potential to help the rest of us.

Posted onDecember 1, 2012|Comments Off on Exercise Does and Doesn’t Help With Weight Loss

With regards to TV’s “The Biggest Loser” show:

The show’s 24-week regimen consists of approximately 4 hours of daily exercise, including 1 hour of intense resistance, 1 hour of intense aerobic activity, and 2 hours of moderate aerobic activity (for example, walking), along with a caloric intake of at least 70% of estimated resting daily energy expenditure, explained Dr. [Robert] Huizenga, who is a former team physician to the L.A. Raiders football team.

If you’re not familiar with resistance training, a personal trainer is an great idea

Yes, exercise helps with weight loss. But most folks aren’t willing or able to exercise vigorously for four hours a day. Physical activity is more important for maintenance of weight loss, when it demands much less time.